Remarks to the National Association of Community Health Centersby HRSA Administrator Mary K. Wakefield

March 22, 2013Washington, DC

I’m happy to be here again -- this time at the start of the Obama Administration’s second four years in office.

As incredibly busy as all of us in this room were during the past four years, now – as we’re well into the first year of this second term – we’re pushing forward together to finish building out the platform of the Affordable Care Act, a platform on which so many improvements in health and health care rest. Many of those improvements have already been achieved; others are on schedule to be met.

But before I talk about our immediate and future opportunities and challenges and what we need to do in the months ahead to meet them, let’s just for a very few minutes consider the enormous progress we’ve made collectively over the past four years, during President Obama’s first term.

Perhaps most importantly, by working together so many more people across the nation – people who need it most – have been able to access quality health care. At the start of 2009, health centers served about 17 million people; now, once we see the final UDS reports, you’re projected to serve well over 21 million patients at the end of 2012. For each of your long-standing health center patients and for those millions who are new to your doorstep, this expansion in access is a massive accomplishment in a very short time. So thank you for everything that you’ve done to create a place for all of these people to find health care.

And together, we at HRSA and you across the nation now serve these people at more sites – and at improved sites. Since 2009, we have added more than 400 new access points, expanded service capacity to meet the increased demand for services at more than 1,100 health centers, and supported the construction of more than 800 new sites and the renovation or modernization of nearly 1,900 sites. What a remarkable achievement that you’ve helped to lead in investing and expanding in communities across the country!

And over the past 4 years, together, we’ve created jobs. Since 2009, health centers have added more 25,300 new full-time positions, increasing employment from 113,000 to more than 138,000 staff nationwide, including:

12,500 case managers, health education, outreach, and transportation staff; and all the other incredible health center staff that contribute to the mission of the health center program in equally important ways.

And these employment expansions contribute not only to the health of people served by health centers but also to the economic health of their communities. What an important investment this has been – especially important because these jobs have been built out against the backdrop of some tough economic times.

And, together, we provide better care than ever before. In 2010 – just two short years ago – fewer than 4 percent of our health centers were recognized as Patient-Centered Medical Homes. Today, HRSA has 248 health centers that have achieved PCMH recognition. That translates to more than 20 percent of all health center program grantees. Four percent to 20 percent in just two years – in health care, that’s like moving at the speed of light!

And, again, in 2010, less than two-thirds of health centers had achieved Electronic Health Records adoption. By 2011 – just a year later – this had increased to four-fifths of health centers. This is a very important accomplishment that strengthens the IT platform which health centers and health care systems need to operate.

And related to health centers, we’ve also made gains in other important areas that support your growth and stability.

For example, in the National Health Service Corps – so many of whose clinicians work in health centers – we nearly tripled clinicians in the field during President Obama’s first term. Thanks to investments totaling $1.8 billion from the ACA and the Recovery Act, we’ve increased the ranks of the NHSC from about 3,600 clinicians in 2008 to nearly 10,000 in 2012. This is another part of HRSA that stood up a major effort in very short time to make a marked difference in access to important health services and that, in the process, extends the reach of so many of your health centers.

Additionally, the ACA stood up a new Teaching Health Center Program which – as many of you know – provides payments to support expanded medical residency training in community-based training sites. The focus is sharply on strengthening primary care training in community settings, where people tend to get most of their health care.

Research indicates that teaching health centers produce primary care physicians who are three to four times more likely to provide care for underserved populations in community settings than physicians primarily trained in hospital settings. So, we’re not just focused on preparing more providers, we’re also focused on harnessing training opportunities that reflect an important new orientation for the next generation of health care providers.

The Teaching Health Center program currently supports 137 new primary care medical residents, and in FY 2013 we plan to more than double that number.

Also highly relevant to the work that you do, at HRSA we’ve invested in team-based care by funding the Center for Interprofessional Education and Collaborative Practice at the University of Minnesota. This is an effort that has the potential to push our knowledge of the value and application of coordinated care to new levels.HRSA launched it late last year with a $4 million, five-year grant, and the Center’s promise to do important work is reflected by the fact that four respected national foundations pledged an additional $8 million to the project, bringing total funding for the Center to $12 million over five years.

The grant to Minnesota will help students and health professionals across the country learn how interprofessional team-based care can improve patient safety and reduce duplicative tests and procedures. We feel confident that the Center’s work will contribute to transforming today’s fragmented health care delivery system to one which values coordinated care that engages across health care settings. This is a path that health centers are already on, as I noted earlier with your progress in implementing the PCHM model.

Well, more broadly, as we consider the ACA’s provisions, currently we’re on the home stretch of implementing this law. Parts of the law are still being rolled out, but – as we get ready to celebrate its third anniversary tomorrow – many provisions have already made a big difference in the lives of millions of Americans.

And just to illustrate some of the progress to date:

Consumers have new protections. For example, 115 million Americans no longer have to fear that their benefits will disappear when they need them most because their insurers put lifetime caps on the amount of care they’d pay for.

3.1 million young people are now on their parents’ health plans until they are 26 years old – young adults with insurance coverage because of this law.

Tax credits for smaller employers are reducing the cost of providing insurance for their employees.

71 million additional Americans with private insurance have accessed preventive services like cancer screenings and flu shots without paying a dollar out of pocket. As a nurse, I know full well – as all of you do – what an important health strategy preventive services are.

And seniors have increased access to preventive services, too, and 6.1 million Medicare beneficiaries have saved an average of $700 on their prescription drugs, again as a result of this three-year-old law.

And those are just a few of the many benefits already in place.

With all of this underway, we can turn our attention to what’s next. Well, looking forward, I know that some people have wondered how health centers will fit into the post-ACA future. From our view, health centers will continue to be a critical element of U.S. health care for three major reasons:

First, health centers are an accessible and dependable source of primary care services in underserved communities.

Second, there will continue to be medically underserved individuals and they will look to health centers as their source of affordable preventive and primary care.

And third, many of the critical services that health centers currently provide – like oral health and enabling services such as case management, transportation and translation – will not likely be consistently covered by health insurance reform. Yet we know that these services are critical to meeting the needs of medically vulnerable populations.

Additionally, we have the example of Massachusetts, which demonstrated how health centers remained a vital source of primary care as the state moved toward full insurance coverage following its health insurance reform. After reform, health centers there actually saw an increase of patients. In fact, from 2005 to 2011, the overall number of health center patients in Massachusetts increased by nearly 43 percent, even as the overall percentage of uninsured patients decreased by over 14 percent.

Now, of course, we face an expansion in access to care similar to the one in Massachusetts, but on a continental scale. The landscape is definitely changing. To traverse it, with an estimated 27 million newly insured looming just over the horizon, you – and we – have a lot to do, and the deadlines for action under the ACA are quickly approaching. It isn’t easy work, but it is, of course, incredibly important work.

First among the things for health centers to do, as a category of Essential Community Providers under the ACA, is to work with potential Qualified Health Plans and Medicaid Managed Care Plans to explore joining their provider networks.

Qualified Health Plans, of course, are the private health insurance plans that are approved to be offered for sale through the Health Insurance Marketplace starting in 2014. Safety-net providers like you need to be reaching out to health insurers now to get into their networks, because many QHPs will be asked to finalize their networks for next year by April 30 of this year. The challenge if you don’t get in the QHPs, of course, is that patients who join plans of which you are not a part will go elsewhere for their care – if they want their new insurance to cover their services.

But while you’re taking that essential and immediate step of reaching out to Qualified Health Plans, you also need to undertake the virtually simultaneous task of educating your current patients, as well as the broader community you serve.

First, you want to be sure that your patients and communities are aware of the new options for obtaining health insurance that will be available starting in 2014, and how these new options will work. The challenge, of course, is that many of the people who stand to benefit most from the expansion of access to health insurance next year may not yet know about what’s coming down the pike.

For example, a recent study found that among uninsured Americans who are likely to quality for health insurance subsidies, only 22 percent were aware of the subsidies at all. And among those likely to qualify for Medicaid under the expansion, an even smaller number – 17 percent – was aware of the possibility of this coverage.

Some patients will also benefit from education about how insurance works – such as how premiums and deductibles function, and the fact that not all plans allow them to see all providers. They’ll need to be made aware that if they want to stay with their current provider, they must select a plan that includes that provider.

Your patients and their families may also benefit from help with finding out what they’re eligible for, and help in enrolling in insurance plans. Starting October 1, each State’s Marketplace will have an online site where individuals will be able to find out if they are eligible for Medicaid or for federal subsidies to help pay for private insurance. And they’ll be able to enroll in an appropriate insurance plan, either Medicaid or private. Individuals will be able to apply online, over the phone, via mail, or in-person.

Across these activities, health centers can play an important role in helping their patients navigate this eligibility and enrollment process.

From our front, the federal government is working hard to get the word out to the public through www.healthcare.gov, which houses the Health Insurance Marketplace.

I urge you to send patients to healthcare.gov, to help them make the best decision about health insurance coverage. I ask you to link to healthcare.gov, include it in emails, post the widget on your organization’s website, put it in newsletters, and recommend it as an information source to your patients, to friends and family members and through your civic and professional organizations.

So, as we move to finalize our joint efforts to implement the Affordable Care Act, let me conclude by saying that I really hope you feel the same sort of excitement and pride that I feel in what our partnership is doing on behalf of all Americans, but especially on behalf those most vulnerable. It is historic, even as it is challenging and even trying at times.

Certainly health centers can expect an increase in demand for your services, and that will lead you in very concrete ways to assess your infrastructure – including, for example, staffing needs and strategies.

On the plus side, how will the extra resources the newly insured will bring in affect your operating model and your ability to maintain and improve your workforce?

Furthermore, from HRSA, we still have about half of the ACA investment in health centers that we’re on track to allocate. At the end of FY 2012, HRSA had spent $3.7 billion in ACA funds for health centers, with $7.3 billion remaining. At the end of FY 2013, HRSA projects that a total of $5.2 billion in ACA funding for health centers will have been spent, with $5.8 billion remaining.

So with that in mind, as I look ahead to the next year and full ACA implementation, I see your strength: clearly, you are trusted advocates for the populations you serve, and your experience in serving the underserved is unmatched.

And, most significantly, the Affordable Care Act itself recognized your value to improve health care in America by investing billions of dollars in an unprecedented expansion of your sites and services.

So, I’ll just close by saying: We’re here to help you run great programs. We’re here to support your continued efforts to improve quality through Patient-Centered Medical Homes and Electronic Health Records. And, finally, we’re here to ask you to please do what you can to really target the hiring of our veterans.

On this last front, I’m proud to say that HRSA and NACHC have joined forces to help health centers hire an average of one veteran per grantee site over the next three years. Our shared goal is to hire 8,000 veterans, and I’m pleased to tell you that about 10 percent of the new hires last year at health centers were veterans. And HRSA is also working with the Departments of Labor and Veterans Affairs to make sure that veterans are aware of health centers as potential employers as well as being health care providers.

Finally, I urge you to keep the two-way dialogue with us at HRSA open and flowing. That way we’ll accomplish everything that we need to over the next couple of years and, in the process, we’ll bring to fruition the promise of a more equitable – and a healthier – America.